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jschultz3

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I received this email from a physician and have never heard this before. Can someone please advise me if this is a correct statement.

-A potential issue that might be on the horizon in terms of "down coding" our US exams (93970, 93971). Essentially, the words "Duplex" and "Doppler" are NO LONGER interchangeable (from a billing perspective). The "Duplex" exam is considered (coding-wise) as the "all inclusive" exam, while the "Doppler" exam is more limited. The danger is that we could have our claim either rejected or down-coded.-
 
From the CSI Navigator:

Doppler: involves measuring change in frequency when the motion of vascular flow is detected.

Duplex: an ultrasound technique that combines doppler and real time imaging capabilities, either simultaneous or sequentially performed.

A duplex scan includes both conventional ultrasound (B mode) and spectral and color doppler.

This is a huge documentation issue right now after our most recent external audit. I think a lot of it stems from the idea that the words are interchangeable. There are very specific documentation requirements for the duplex codes. Namely, the duplex must document color flow AND spectral doppler was performed. Also check the code description, as in 93975, must document the arterial inflow and venous outflow.

The RBMA put out a list of "buzzwords" for proper duplex documentation in their Coding Academy Resources 2011.

Hope this information helps you out!
 
Also, regarding the 93970/71, this is from our auditing company (June 2012):

Duplex scans such as 93971 – extremity venous – require both color and spectral doppler. Codes 93970 and 93971 include compression and other maneuvers, if performed, but the use of compression does not negate the need for spectral analysis. Subsequent to the initial review of these exams, we discussed with ACR vascular exams that do not include spectral analysis. It was determined that cases such as this would be coded with the non-vascular extremity code 76882. ACR has changed their Ultrasound Coding User's Guide to reflect this.
 
Post Chest Thoracentesis and Tube Placement

Hello, if in cases of Post Chest Thoracentesis and Tube Placement and they are looking to see if there is a pneumothorax development, would this warrant medical necessity? Thanks.
 
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